MEDICARE: JEFFREY STONE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26012971A	IN

General Provider Information

NPI Number	:	1457780009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY STONE RPH

Provider Business Mailing Address
First Line	:	1228 PERRY LAKE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-2354
Country	:	US
Telephone Number	:	260-637-0819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 PERRY LAKE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-2354
Country	:	US
Telephone Number	:	260-637-0819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/04/2013

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Directions to “ JEFFREY STONE RPH” Practice Location

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